脑小血管病步态障碍的影像特征与危险因素研究

Imaging Characteristics and Risk Factors of Gait Disorders in Cerebral Small Vessel Disease

目的探讨与脑小血管病(cerebral small vessel disease,CSVD)步态障碍相关的影像特征。方法连续收集2018年7-9月在青岛西海岸新区人民医院神经内科住院的CSVD患者,记录入组患者的性别、年龄、吸烟史、控制不良的高血压、高脂血症、HbA1c、无症状性梗死、室周白质高信号(periventricularwhitematterhyperintensities,PWMHs)评分、深部白质高信号(deepwhitematter hyperintensities,DWMHs)评分、皮质萎缩(外侧裂比值)、皮质下萎缩(尾状核指数)及颞叶海马萎缩(海马沟回比)等资料。按照Holden步行功能分级(functionalambulationclassification,FAC)≤3,分为跌倒低风险组(low risk of falling,LRF)和高风险组(high risk of falling,HRF),采用多因素Logistic回归分析CSVD患者步态障碍的独立危险因素。结果研究共纳入102例CSVD患者,其中HRF组59例(57.8%)。单因素分析提示HRF组与LRF组的年龄(P<0.001)、HbA1c(P=0.007)、PWMHs(P=0.002)、DWMHs(P<0.001)、外侧裂比值(P<0.001)、尾状核指数(P=0.003)及海马沟回比(P<0.001)差异有统计学意义,多因素Logistic回归分析显示年龄(OR 1.173,95%CI 1.053～1.306,P=0.004)、DWMHs(OR 8.883,95%CI 2.674～29.512,P<0.001)及外侧裂比值(OR 1.433,95%CI 1.028～1.999,P=0.034)是CSVD步态障碍的独立危险因素。结论 CSVD患者步态障碍的独立危险因素包括年龄、皮层萎缩及DWMHs评分。

Objective To investigate the imaging characteristics of gait disorders in cerebral small vessel disease(CSVD).Methods This study consecutively enrolled patients with CSVD from neurology department of People’s Hospital of Qingdao West Coast New Area from July 2018 to September 2018.Baseline data were collected including gender,age,chief complaints,smoking,hypertention,hyperlipidemia(HLP),HbA1c,silent brain infarction,periventricular white matter hyperintensities(PWMHs),deep white matter hyperintensities(DWMHs),cortex atrophy(sylvian fissure ratio),subcortex atrophy(caudate head interval ratio),hippocampus atrophy(interuncal distance ratio).Impaired gait was defined as the Holden functional ambulation classification(FAC)score≤3,and all patients were divided into low risk of falling group(LRF)and high risk of falling group(HRF).Univariate analysis and multivariate Logistic regression analysis were used to identify the independent risk factor of severe gait disorders.Results A total of 102 CSVD patients were identified,including 59 cases(57.8%)in HRF group.Univariate analysis showed that age(P<0.001),HbA1c(P=0.007),PWMHs(P=0.002),DWMHs(P<0.001),sylvian fissure ratio(P<0.001),caudate head interval ratio(P=0.003)and hippocampus interuncal distance ratio(P<0.001)were correlated with tumble.Multivariate Logistic regression analysis showed that age(OR 1.173,95%CI 1.053-1.306,P=0.004),DWMHs(OR 8.883,95%CI 2.674-29.512,P<0.001)and sylvian fissure ration(OR 1.433,95%CI 1.028-1.999,P=0.034)were independent risk factors of tumble in CSVD.Conclusions Advanced age,high score of DWMHs and obvious cortex atrophy were independent risk factors of tumble in CSVD,and patients with such risk factors should be paid more attention to prevent tumble.